One last check before sleep

After the sixth baby is born and tucked in, beside their mother, I walk from room to room, one more time before taking a shower and lying down. Every bed has a few people in them. Two grandmothers from different families sleep on a single bed; their two great grandchildren born within minutes of each other in beds on either side. Their heads, sharing one pillow, are wrapped in a swirl of lace and cloth.

Two very young cousins snuggle into a bed with the new baby they both worked so hard together to help be born. They make a heart with their sweet, teen age bodies around this new tiny little girl.

Moms in bed and Dads beside them on blankets on the floor. The occasional sound of a baby crying and asking to be put back to the breast.

Relatives from different families, who never went to sleep, sit on the porch talking with one another and sharing food. Outside, there is the sounds of the sheets being washed by sisters or aunts, squatting over tubs of water as they talk of birth and the days to come. The roosters and cows and goats remind me that although my day is just ending, it is morning here.

The skies are a gentle pink behind the mountains they call Mourn Rogue or the Red Mountains. They are a gentle slope of an ancient volcanic mountain range that is mostly buried beneath the sea, leaving 700 islands here in the West Indies. I tell the TBA that Haiti was once a volcano and I can see that she thinks this is just another one of my tall tales like a cervix opening inside a mother. She smiles at me and shakes her head and does not believe a word of it.

The mountains are the background of all our days and seem to hold us tenderly in their long sloping arms. I look out at them and the sunrise and then find a little rest.

Disney princess on a cloud of mosquito netting

Yesterday this premature baby was sleeping on a cloud of mosquito netting in her tiny Disney princess dress. She was born here and her Mom comes back regularly to eat and nap and get support with breastfeeding.

Spahgetti in the cord clamps !

After a busy day of births, I hurry to sterilize the instruments and a new cord clamp. We only have three sets so I have to set my mind to it first thing after a birth. I wash them and then look for a source of heat - charcoal, propane or electric depending on the day. The other morning I set them to boiling and imagine my surprise when I came down and the breakfast spaghetti was in with the scissors and clamps. I fished the instruments out and wrapped them up, determining it was still boiling water so it is okay.

However, I did not eat the spaghetti served that morning for breakfast !

Big sister

I was busy delivering this baby when I happened to look over and see this little girl peeking through the door at her mother in labor. Here she is with her new baby brother.

Patience

We have three more births on Saturday. I wake up and by six there are three women in labor and all the families on the porch watching through the window as I scurry about setting up a third birth room and walk in a circle bringing water, charting and taking vitals. They are all in hard labor and we wait to see who will give birth first. I think to myself " this is hard but I have it under control. " I walk around again. I catch one baby and Marie another and it goes well.

There is pause and number three who is having her first baby does not push. I look at her chart. Her name is Rosealine. It is common to to have an aline at the end of names. I say, "Rosealine" and she opens her eyes. I then witness what I now know as the shaking method of medicine which is if you don't know what's wrong and why, just shake or smack it and it will all turn out. A wide variety of relatives come and yell at her and shake her hard, despite my protests. Then the TBA comes in and thinks a good yelling and shaking will also help and then I scream at all of them and get the baby out- slightly premature and covered in meconeum ( baby's poop) which is not good. I am trying to suction the baby and they decide a good shake of the baby is good for whatever ails it too. But the baby is little and slippery and I am trying to make sure it does not breathe it in. Shake, rub. I say "no". A word they understand. I put the suction back in my mouth and the TBA grabs the babys face and starts to push dimples into its tiny, green face and I become hysterical. I loose all patience. The mother is bleeding so they pounce on her. Rubbing and punching her stomach. I say it is not her utereus. You have to feel and watch- not just grab mothers and babies and utereus's and pound and rub and smack them into existence.

When the bleeding has stopped and the baby is nursing and no longer green, I pick up and walk outside. I think about how frustrated I was. How I just wanted to be alone and take care of the mother and baby without all this yelling and rough treatment. Later I think about how if you could not read and had no books or medicine you would develop customs that might help and if you thought someone might die, it might just help to shake and yell the life back into them and I suppose in the case of babies and moms and utereuses it might have sometimes worked. At least worked better than nothing at all. I feel ashamed and tired.

The TBA brings me warm tea and gives me a kiss. I am so sorry I was not more patient. I show them pictures and try to explain but they think I know some things but not everything and a good smack helps many things. I try to say a good smack doesn't help anything - not really and they look at me but do not believe me.

After all the washing of the laundry, by all the relatives in the back yard, they go home and it is quiet.

The cook has asked for money for some fish and I give her a few dollars and ask to see what the fish look like when she returns. There are six very little fishes. I look down at them and think how will they ever feed all these people. Six little fishes. I watch them eat every part- licking he inside of the heads with joy and satisfaction. I wonder who gets the head as it seems to be a treat.

It is dark by 6:30 and I go to bed.

The moon is a crescent again. I have been here one month; one full cycle of the moon.

the dreams of a midwife

There is a wave of births; first one and then another and another and another.   I dream I am swimming in  a warm blue sea with the mothers and babies and the baby takes my hand and says, '"we'll do this together" and we drift in a place of dreams and trust until we come ashore and they are born. I dream and then more and more come.  Eight  babies to scoop up before they reach the floor in a swish of warm water, to breathe life into, to wrap their mothers reluctant arms around, to bring to the breast, to weigh and dress, to wipe and clean and change the sheets and begin again as the one before smiles and waves good bye and walks down the dirt road to home and family and another comes.

When I close my eyes, I am standing on the beach and the waves carry all these babies to me.  They are  laughing and cooing and I am collecting them like beautiful seashells and with my arms full, I carry them to their mothers who are waiting.

These are the dreams of a midwife, even now as it grows quiet

A free public education for all the children!

I jumped for joy yesterday when I heard that the legislature had passed a bill providing a free education for each child in Haiti. This will lay the gound work for change in Haiti as nothing else can. I am just so happy that come October all the children will get up and walk to school and I can watch them pass by. I know we will all be smiling a very special smile. All the marines in the world can not bring about democratic change as well as an army of dedicated teachers who love their students.

This is me with a new baby. mom, dad and Udel who is a traditional midwife who came and stayed and worked with me  This is the postpartum room

Many people make up my home in Haiti

It is 9:30 am and two mamas and babies are resting in the postpartum room on clean sheets with plates of fruit and porridge. It is Sunday morning and I tell the new Haitian midwife we are training that birth is a way of knowing and thanking God, in our own private way; for the miracle of it and that so often it all goes so perfectly. For the hope and possibility of that sweet new life.

In the place I live, everyone who is here, works to make that possible. There is Jason and his son Junior who bury the placentas and answer the knocks on the gate or call for transport to the hospital. They live in very small, tidy rooms outside and are a constant presence. They help with the garden and our the security which often means sitting outside by the gate visiting with those who pass by. Santo, the community health worker lives here and Marie the Haitien midwife and then any volunteers. Everyday our numbers swell with moms and babies, visitors and guests. I live upstairs in a dorm like life with communal meals and beds here and here. We move from our "home" to work in an instant, never knowing what will come our way or what the next moment will bring. The cook and the person who cleans and washes the clothes and sheets come each morning and stay until late. They sing and laugh and I can hear them chopping vegetables during the day. Their children come to and play here as well.

We all dream big dreams for Haiti and her children. We try to learn to talk each other's language and to make birth for the babies in the surrounding villages a safer, sweeter part of life.
I am never alone even when I am sometimes lonely for friends and family and those things sweet and dear to me.

Santo's graduation

Yesterday Santo, who is the much loved translator here, graduated from a health outreach program put on by the United Nations for him and about 20 other health workers in north Haiti. It was a six month class to help with issues of public health. Santo, amongst other things, will run a family planning clinic here one morning a week and do immunizations.

It was in Cap Hatien at a Hatien fancy venue with lots of US elevator music and pomp and ceremony; a part of Haiti I had never seen. Many people from NGO"s with the person their organization sponsored. Networking is awkward but I am desperate for resources and information. They made up their own version of We Are The World - about their work in Haiti which was moving after hearing others sing for and about Haiti in the United States.

There was piles of food, caps and gowns, speeches and picture taking and supplies from UNICEF to take home. Even electricity the whole time!

It was a moment of hope and pride as we all happily made our way home over bumpy roads; the car packed with people and chatter. I noticed keresone lanterns lighting small groups of people who gathered with friends in the cool evening air; small fires cooking the nights meal and children playing there beside them.

I am most often on call at the clinic and so it was a much appreciated outing. We came home and put on head lanterns and told good stories of the day before each found their place to sleep which changes with the weather.

Not yet born

Yesterday a laboring woman was brought to us. I walked into the birth room and saw that the cord was hanging from her and the baby had not yet been born. She had walked here this way. I tried to save the baby but deep inside I knew it was too late and that the baby had died some time ago. The cord was not beating and was cold in my desperate hands. I tried to tell everyone what to do but they didn't understand a word I was saying and really it didn't matter.

Later I just laid down on the floor and watched the storm come in and could not do anything at all but watch the sky and surround myself with quiet.

Prayers

How many prayers do we get in a day or a night? If I use them on one baby do I still get more, later in the day when I need them again, when I don't have the right tools or medicine or hospitals and I feel alone except for that spirit that stays beside me loving and calm and reassuring.

Unexpected twins !

A mother arrived yesterday with one baby on her chest still connected to the cord and another one on the way. She was having her baby at home with a local TBA and when they realized it was twins and decided to carry her into us. So much to consider so fast in such a little amount of time. I cut the first baby's cord and gave her to Zeenia, the naturopathic doctor who has been here and is soon to leave. Listen to the second baby's heartbeat. Great. Head down. Great again. No contractions. The mom asks if she can get onto the floor and stands up and the second baby swooshes out and I have to scoop him up off the floor; all wet and crying. The two placentas lingered and the thoughts that there is no ambulance and she is bleeding filling my head but all went well with prayer and pitocin and in time, mom and the twins were tucked into bed and the family was washing the sheets out back. I was thankful that it was still light out and we did not have to do this by lantern and thankful that they were all well and healthy and everyone worked together. I went upstairs and took a much appreciated bucket shower and laid down outside with much gratitude.

Market and food

On Tuesdays, the cook goes to the market in Cap on the tuck tuck. The tuck tuck is a pick up truck with a top that is brightly painted and honors Jesus by name or pictures. Many people and things squeeze in and the speed along mostly dirt roads with big holes but there is some sign of an effort at paving. The road to Cap is lined with small markets and people walking and visiting and businesses of all sorts. I guess our version of a strip mall and the market in Cap is the big market that takes up many streets and each stand seems to be covered in a single, small umbrella so it looks like many umbrellas all down the streets.

They bring back eggs, fruit and three live chickens that are killed and eaten during the week and live in the chicken coop until that time. I will try to get baby chicks and start laying hens again. They tried, but something got them as can happen everywhere.

There is a place that bakes bread on great charcoal griddles under the trees along the way.

The cook prepares three big meals a day. Porridge spiced with cardamon for breakfast with fresh fruit and then some form of rice and beans with sauce for lunch and dinner. Vegetables are cooked into a sauce. They are mostly potatoes and plaintain and a few peppers in a tomato sauce. There is a stove, when there is electricty, and a propane stove but she seems happiest with the charcoal outdoors. Food is stored in buckets and there is no refrigeration. These plates of rice and beans are filling and overall I think are healthy enough in many ways. Most people I see eat one meal a day and so suffer from a lack of clean water, stomach aches from long hours with no food and a lack of some vitamins and minerals.

They do not have fermented food as many cultures do to help with heat and storage. No dairy or fermented vegetables. Dried fish but not dried fruit that I have seen. I am sure I will learn more about the food and how to advise the women I see within their culture and with what is available.

I am learning about the native plants and their uses and hope that I can make that a part of our pharmacy. I have transplanted some into our garden, much to the amusement of those who helped me.

Movie night with the orpahanage and village children

It was Friday night at the movies with popcorn popped on a charcoal fire and a film about lions on a computer as there was no electricity and the battery back up was too weak for the projector. Still we played jump rope games and then they all sat on the floor and ate popcorn by the bowl full and watched the animals of Africa on the screen with wonder. All the people who work here watched too and it was this moment of peaceful joy and community. The head of the orphanage asked if they ate the lions. It is my hope to teach geography in some small ways through these movie nights. We ended with a fine time of singing. As the sun set golden and pink, they walked back down the road amongst the goats finding a place to sleep for the night on small ledges and crevices of concrete. We waved good bye and promised to do it again soon.

As they walked out one door, a woman in labor came in the other. I put on my head lamp and sat beside her and set out to discover how she was doing and how soon the birth might be. Early labor so I set out to sleep beneath an almost full moon on the porch and slept the whole night and so did she.

When it rains

Marie, the midwife from Hench, who left so quickly to go home when I arrived is suppose to return today but calls to say Monday instead. I worry that she might not return at all as she is so far from her family and young children. This would be, of course, understandable, but still we need more than one midwife here.

It rains though and when it rains they do not come to the center but have their babies under tin roofs with local midwives and come to see us in the morning. Or they do not come because they can not find or afford a motorcycle ride and it is too dark to walk. Yesterday morning a woman walked to see me only a few hours after the birth; the baby's cord bleeding quite badly. I have become accustomed to this and quickly re clamp and cut it and bathe it in alcohol; wrapping the baby back up and handing her to her strong mother. The baby was dressed in a very frilly pink dress and blanket and booties so I was quite surprised to remove the diaper and find a boy.

I try to teach, Audel, the traditional midwife who I have brought to stay with us about washing and boiling the scissors for a birth. I motion to boil them quick while the electricity is on and I find her standing with the scissors staring at the stove and I realize she has never seen one before and I am sorry for my assumptions. I show her how to turn the stove on and boil the scissors. I want her to do this when she leaves here to practice again in the poorest neighborhoods of Cap Hatien but I don't know how she can. She says she will bring many traditional birth attendents to study with me and I say yes but wonder where to begin. Haiti has the highest infant mortality rate in the western hemisphere and most babies are born with traditional birth attendents at home with no training. Adul says they cut the cord with rusty razor blades and I think, at least,w e should be able to give out clean razors and sterile clamps.

Paul Farmer's book the uses of Haiti is his best and quite a lesson in United States history as well.

Clothes

In Haiti, the clothes donated by other countries, are sold in small markets and so most of the women come to the clinic in the cutest and most fashionable outfits and I always think they look better on them than the first time around in the US. Tight jeans and sweet skirts, shoes and hats. They live with no electricity or running water and show up just as cute and done up as can be. Recently a young woman had her baby and was back in her skin tight jeans lying in bed nursing 30 minutes later! The houses are often no larger than our garages, with many people so I am deeply in awe. A traditional house is painted bright colors and in a cluster with perhaps a pump and outdoor cooking area. Work, including wash is all done in the "yard" where children play. I suspect the houses that share one yard are related.

A concern, I try to share, is that US baby clothes are too hot for Haiti and so babies are arriving in wool and layers with temperatures of 102 ! so this is not working well for babies. Their own baby clothes are light, brightly colored and perfect.

My own clothes are washed outside and perhaps over bleached as the flowers fade away. I can barely stand to wear a sundress it is so hot. I feel badly about so much handwashing and it is easy for me to rinse out many of my own things. The families are expected to do their own birth laundry so they are out there scrubbing away, even the fathers.

There are cactus fences and it is common to see the clothes hanging from them as i walk down the road.

The children in the orphanage do not seem to have access even to the second hand markets so i am sure some nice clean t- shirts would be appreciated.

I hear a birthing woman approaching. Sounds like better run fast!

Party at the birth center

When some of my children were teenagers they discovered the many benefits of having a midwife mom; one of them being the use of the birth center for social gatherings or "party tonight at the BC." This went on happily, without our knowledge, for some time until they were discovered and good times such as those put to rest.

Party at the birth center has taken on a new meeting here in Haiti as the women begin to gather outside the wall at 4:00 am to wait for the clinic to open. Most walk or take the tap tap or some arrive on motorcycle taxis. They laugh, talk, joke and pass the time. In time, the market women will come to sell fruit or other food, littering the ground with this and that. It is, I can see now, a place to gather and meet friends. They come in small groups, leaving children it seems at home, for what must be a relaxing day off from so much work.

The women describe their work as working in the yard - getting water, washing by hand, cooking on charcoal and growing some food.

I had felt badly about the long wait ( and still do in many ways ) but here in the early morning as they laugh and talk, I understand its " a party at the birth center" and all are invited. We have started filling old vitamin bottles with clean water for the long walk home in the difficult heat of the afternoons.

A woman has just arrived in labor and the clinic needs preparing for the day and so my day begins.

A knock on the gate at 2:00 am

I sleep, when I can, on the porch where the skies are full of stars and the breezes are cool and sweet. The frogs break the silence with a rowdy burst of conversation that wakes the roosters, that wakes the cows. But even in one week I have grown accustomed to these noises and wake only to the knock at the iron gate as a woman in labor comes to our door. Yesterday four women came; the last at 2:00 am. The little head appeared the moment she lay down and she was tucked in, babe in arms, by three.

In my first week, I have delivered eight babies and sent two to the hospital; one who arrived in bloody sheets and another who I feared a cord prolapse. An average clinic day is about 20 prenatal appointments and another 10 or more babies to see. Sending a woman to the hospital, at this point, means back out onto the road to find a ride on a motorcycle so it is a hard choice to make.

Although I am still sleepy from the birth I have gone for my morning walk and will soon be treated to breakfast prepared each day for us by the cook who creates amazing dishes with very little and an art for the use of spices.

I have quickly become accustomed to this life, grateful for the wonders I see and offering the sorrows to my prayers before bed. I sleep early, preparing for the knock on the gate that may soon awaken me.

Morning walks

The mornings are soft and beautiful with the sun rising over the mountains as I wake on the sleeping porch. The women come very early to line up for the clinic; laughing and talking for many hours before they can be seen. They begin to arrive at 5:00 am and the clinic does not begin until 9:00 am. I walk out into the road and greet them and then go for a short walk practicing my creole; passing farmers with their cows and goats and the women who are going to and from the market. I try to begin to try to understand the plants and the families and the traditional uses. A local midwife ( madrone ) has come to stay and is wise in the use of plants so I ask her many questions and am taking rootings in old vitamin containers and hope to soon plant a small medicinal garden. By afternoon I will be hot and tired from seeing so many patients so I value the time of my little walks and the many things it teaches me.

Papaya leaves for a vaginal infection and almond leaf tea for high blood pressure.

Yesterday I delivered two babies - two fine little boys